This brief lives on this device only. It is not a medical record or a care plan — it is what you’d want the next person to know.

Family Brief

Last updated: —

Person’s nameDate of birth

Diagnosis dateDiagnosing neurologistDischarge dateDischarge planner

ALS clinicSingle point of contact (name, phone)

Service ordered: home health / palliative / hospice — agency, phone

Care manager (ALS Association / ALS Crowd) — name, phone

Palliative / hospice — contact namePalliative / hospice — phonePalliative / hospice — night numberRespite notesBereavement contact

Medical POA holderWhere the advance directive is filed

Medications

Last reconciled

Breathing decision — what was decided, date, can be revisitedFeeding decision — what was decided, date, can be revisited

Last updated: —